Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
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Strategies to Prevent Obesity-Related Cancer-Reply
Massetti GM , Dietz WH , Richardson LC . JAMA 2018 319 (23) 2442-2443 Trends in the negative health consequences of overweight and obesity are on the rise, coinciding with trends in rates of obesity. It is therefore not surprising that obesity accounts for a significant portion of health care costs in the United States.1 As Dr Chen and his colleagues point out, our Viewpoint emphasized the opportunities for comprehensive approaches to preventing obesity-related cancers within health care settings. To achieve significant effect on obesity and obesity-related cancers, all tools of the medical and public health community must be brought to bear on the problem. Chen and colleagues propose bariatric surgery as a treatment for severe obesity and a strategy for cancer prevention for eligible patients. As they note, achieving sustainable weight loss among patients with overweight and obesity presents significant challenges. For these reasons, efforts to prevent further weight gain among those who are not yet obese—and would not be eligible for surgery or other invasive medical approaches to treating overweight—are critical. For patients with obesity who have not been successful in losing weight, health care professionals can consider a variety of strategies that meet patients’ needs, including surgical approaches. Data such as those cited by the authors provide empirical links between interventions for overweight or obesity and associations with cancer outcomes. Such findings can inform understanding of the links among weight, weight gain and loss, and cancer. |
Improving access and systems of care for evidence-based childhood obesity treatment: Conference key findings and next steps
Wilfley DE , Staiano AE , Altman M , Lindros J , Lima A , Hassink SG , Dietz WH , Cook S , The Improving Access and Systems of Care for Evidence-Based Childhood Obesity Treatment Conference Workgroup , Foltz J . Obesity (Silver Spring) 2017 25 (1) 16-29 OBJECTIVE: To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e., clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 h over 6 to 12 months to improve weight status) and to expand payment for these services. METHODS: In July 2015, 43 cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. RESULTS: Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multidisciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g., >25 h) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. CONCLUSIONS: Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale up training to ensure quality of care. |
Weight management and physical activity throughout the cancer care continuum
Demark-Wahnefried W , Schmitz KH , Alfano CM , Bail JR , Goodwin PJ , Thomson CA , Bradley DW , Courneya KS , Befort CA , Denlinger CS , Ligibel JA , Dietz WH , Stolley MR , Irwin ML , Bamman MM , Apovian CM , Pinto BM , Wolin KY , Ballard RM , Dannenberg AJ , Eakin EG , Longjohn MM , Raffa SD , Adams-Campbell LL , Buzaglo JS , Nass SJ , Massetti GM , Balogh EP , Kraft ES , Parekh AK , Sanghavi DM , Morris GS , Basen-Engquist K . CA Cancer J Clin 2017 68 (1) 64-89 Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2017. (c) 2017 American Cancer Society. |
Excessive weight gain, obesity, and cancer: Opportunities for clinical intervention
Massetti GM , Dietz WH , Richardson LC . JAMA 2017 318 (20) 1975-1976 Even though the effects of overweight and obesity on diabetes, cardiovascular disease, all-cause mortality, and other health outcomes are widely known, there is less awareness that overweight, obesity, and weight gain are associated with an increased risk of certain cancers. A recent review of more than 1000 studies concluded that sufficient evidence existed to link weight gain, overweight, and obesity with 13 cancers, including adenocarcinoma of the esophagus; cancers of the gastric cardia, colon and rectum, liver, gallbladder, pancreas, corpus uteri, ovary, kidney, and thyroid; postmenopausal female breast cancer; meningioma; and multiple myeloma.1 An 18-year follow-up of almost 93 000 women in the Nurses’ Health Study revealed a dose-response association of weight gain and obesity with several cancers.2 | The prevalence of obesity in the United States has been increasing for almost 50 years. Currently, more than two-thirds of adults and almost one-third of children and adolescents are overweight or obese. Youths who are obese are more likely to be obese as adults, compounding their risk for health consequences such as cardiovascular disease, diabetes, and cancer. Trends in many of the health consequences of overweight and obesity (such as type 2 diabetes and coronary heart disease) also are increasing, coinciding with prior trends in rates of obesity. Furthermore, the sequelae of these diseases are related to the severity of obesity in a dose-response fashion.2 It is therefore not surprising that obesity accounts for a significant portion of health care costs. |
The association between childhood sexual and physical abuse with incident adult severe obesity across 13 years of the National Longitudinal Study of Adolescent Health
Richardson AS , Dietz WH , Gordon-Larsen P . Pediatr Obes 2014 9 (5) 351-61 BACKGROUND: Severe obesity has increased, yet childhood antecedents of adult severe obesity are not well understood. OBJECTIVE: Estimate adult-onset severe obesity risk in individuals with history of childhood physical and/or sexual abuse compared with those who did not report abuse. METHODS: Longitudinal analysis of participants from the US National Longitudinal Study of Adolescent Health (n = 10,774) wave II (1996; aged 12-22 years) followed through wave IV (2008-2009; aged 24-34 years). New cases of adult-onset severe obesity (body mass index [BMI] ≥ 40 kg/m2 using measured height and weight) in individuals followed over 13 years who were not severely obese during adolescence (BMI <120% of 95th percentile Centers for Disease Control and Prevention National Center for Health Statistics growth curves). RESULTS: The combined occurrence of self-reported sexual and physical abuse during childhood was associated with an increased risk of incident severe obesity in adulthood in non-minority females (hazard ratio [HR; 95% Confidence Interval] = 2.5; 1.3, 4.8) and males (HR = 3.6; 1.5, 8.5) compared with individuals with no history of abuse. CONCLUSION: In addition to other social and emotional risks, exposure to sexual and physical abuse during childhood may increase risk of severe obesity later in life. Consideration of the confluence of childhood abuse might be considered as part of preventive and therapeutic approaches to address severe obesity. |
Trends in energy intake among adults in the United States: findings from NHANES
Ford ES , Dietz WH . Am J Clin Nutr 2013 97 (4) 848-53 BACKGROUND: Energy intake is a key determinant of weight. OBJECTIVE: Our objective was to examine trends in energy intake in adults in the United States from 1971-1975 to 2009-2010. DESIGN: The study was a trend analysis of 9 national surveys in the United States that included data from 63,761 adults aged 20-74 y. RESULTS: Adjusted mean energy intake increased from 1955 kcal/d during 1971-1975 to 2269 kcal/d during 2003-2004 and then declined to 2195 kcal/d during 2009-2010 (P-linear trend < 0.001, P-nonlinear trend < 0.001). During the period from 1999-2000 to 2009-2010, no significant linear trend in energy intake was observed (P = 0.058), but a significant nonlinear trend was noted (P = 0.042), indicating a downward trend in energy intake. Significant decreases in energy intake from 1999-2000 to 2009-2010 were noted for participants aged 20-39 y, men, women, and participants with a BMI (in kg/m(2)) of 18.5 to <25 and ≥30. CONCLUSION: After decades of increases, mean energy intake has decreased significantly since 2003-2004. |
The abilities of body mass index and skinfold thicknesses to identify children with low or elevated levels of dual-energy x-ray absorptiometry-determined body fatness
Freedman DS , Ogden CL , Blanck HM , Borrud LG , Dietz WH . J Pediatr 2013 163 (1) 160-6 e1 OBJECTIVE: To examine the accuracies of body mass index (BMI) and skinfold thicknesses in classifying the body fatness of 7365 8- to 19-year-old subjects in a national sample. STUDY DESIGN: We used percent body fat determined by dual-energy x-ray absorptiometry (PBF(DXA)) between 1999 and 2004. Categories of PBF(DXA) and the skinfold sum (triceps plus subscapular) were constructed so that that numbers of children in each category were similar to the number in each of 5 BMI categories based on the Centers for Disease Control and Prevention growth charts. RESULTS: Approximately 75% of the children and adolescents who had a BMI-for-age ≥ 95th percentile (considered obese) had elevated body fatness, but PBF(DXA) levels were more variable at lower BMIs. For example, only 41% of the boys who had a BMI < 25th percentile, had a similarly low PBF(DXA). The use of the skinfold sum, rather than BMI, slightly improved the identification of elevated levels of body fatness among boys (P = .03), but not among girls (P > .10). A low sum of the triceps and subscapular skinfold thicknesses was a better indicator of low PBF(DXA) than was a low BMI, but differences were smaller among children with greater levels of body fatness. Among girls who had a PBF(DXA) above the median, for example, BMI and the skinfold sum were correlated similarly (r = 0.77-0.79) with body fatness. CONCLUSIONS: Both BMI and skinfold thicknesses are fairly accurate in identifying children who have excess body fatness. In contrast, if the goal is to identify children who have low body fatness, skinfold thicknesses would be preferred. |
Is the body adiposity index (hip circumference/height(1.5)) more strongly related to skinfold thicknesses and risk factor levels than is BMI? The Bogalusa Heart Study
Freedman DS , Blanck HM , Dietz WH , Dasmahapatra P , Srinivasan SR , Berenson GS . Br J Nutr 2013 109 (2) 338-45 Because of its strong association (r 0.85) with percentage of body fat determined by dual-energy X-ray absorptiometry, hip circumference divided by height(1.5) (the body adiposity index) has recently been proposed as an index of body fatness among adults. We examined whether this proposed index was more strongly associated with skinfold thicknesses and levels of CVD risk factors (lipids, fasting insulin and glucose, and blood pressure) than was BMI among 2369 18- to 49-year-olds in the Bogalusa Heart Study. All analyses indicated that the body adiposity index was less strongly associated with skinfold thicknesses and CVD risk factors than was either waist circumference or BMI. Correlations with the skinfold sum, for example, were r 0.81 (BMI) v. r 0.75 (body adiposity index) among men, and r 0.87 (BMI) v. r 0.80 among women; P< 0.001 for both differences. An overall index of seven CVD risk factors was also more strongly associated with BMI (r 0.58) and waist circumference (r 0.61) than with the body adiposity index (r 0.49). The weaker associations with the body adiposity index were observed in analyses stratified by sex, race, age and year of examination. Multivariable analyses indicated that if either BMI or waist circumference were known, the body adiposity index provided no additional information on skinfold thicknesses or risk factor levels. These findings indicate that the body adiposity index is likely to be an inferior index of adiposity than is either BMI or waist circumference. |
Eliminating the use of partially hydrogenated oil in food production and preparation
Dietz WH , Scanlon KS . JAMA 2012 308 (2) 143-4 Consumption of trans-fatty acids (TFAs) adversely affects cardiovascular risk factors and is associated with increased risk of coronary heart disease (CHD) events,1 making the reduction of TFA intake key to achieving the Department of Health and Human Services' Million Hearts goal to reduce myocardial infarctions and associated medical costs. Effects of TFA intake include increases in low-density lipoprotein cholesterol levels and decreases in high-density lipoprotein cholesterol levels.1trans-Fatty acids also have been associated with proinflammatory effects, endothelial dysfunction, and decreased insulin sensitivity in persons with insulin resistance.1 To address this public health concern, the Dietary Guidelines for Americans2 and the Institute of Medicine have recommended that TFA intake should be as low as possible.3 This Viewpoint focuses on progress in reducing TFA intake in the United States and the potential health benefits of further reducing intake by eliminating a primary source of TFA. | Some TFAs are naturally present in dairy and meat products of ruminant animals, referred to as ruminant TFAs, and small amounts of industrially produced TFAs are formed during refinement of oils and prolonged deep frying of foods. However, the primary dietary source of industrially produced TFAs is partially hydrogenated oils. These industrially produced TFAs are commonly present in vegetable shortenings, margarines, baked goods, snack foods, and other foods made with or fried in partially hydrogenated oils. The partial hydrogenation process was initially thought to produce fats that were less harmful than saturated fat, but evidence has emerged that TFAs adversely affect health. Current dietary guidelines recommend keeping total TFA consumption as low as possible, and specifically limiting intake of foods that contain industrially produced TFAs such as partially hydrogenated oils.2 |
Implications of the energy gap for the prevention and treatment of childhood obesity
Dietz WH . Am J Prev Med 2012 42 (5) 560-1 The article by Wang and colleagues1 in this issue of the American Journal of Preventive Medicine provides important data that highlight the promise of prevention and raise the challenge of treatment in children and adolescents. The authors have calculated the caloric deficits necessary either to return the prevalence of child and adolescent obesity to 5% as it was in the 1970s, thereby achieving the Healthy People (HP) 2010 goal by 2020, or to reduce the current prevalence estimates by 10%, achieving the HP 2020 goal. As indicated in their article, the caloric deficits needed to achieve the HP 2010 goal by 2020 are 33 kcal/day for children aged 2–5 years; 149 kcal/day for those aged 6–11 years; and 177 kcal/day for those aged 12–19 years. To achieve the HP 2020 goal of reducing the prevalence of obesity by 10%, smaller deficits of approximately 5 kcal/day for the first group, 40 kcal/day for the second, and 31 kcal/day for the third, respectively, will be required. | A focus on mean weights helps set the caloric goals for population-based prevention efforts. However, because the distribution of BMI and body weight among adolescents is not normally distributed but is skewed toward the upper end of the distribution,2 use of mean weights for these calculations does not adequately address the substantially greater caloric deficits needed to reduce weight among obese children and adolescents. |
Reversing the tide of obesity
Dietz WH . Lancet 2011 378 (9793) 744-6 The accompanying four papers in The Lancet1, 2, 3, 4 address several crucial areas relevant to the impact and future course of the obesity epidemic. In the past 30 years, obesity has increased in most countries and regions of the world.5 Boyd Swinburn and colleagues1 emphasise that obesity control will require policy interventions to improve the environments that promote poor dietary intake and physical inactivity rather than individually focused interventions, and that the necessary policy changes are fraught with political challenges not associated with clinical interventions that focus on individuals. | Claire Wang and colleagues2 model the effect of increasing rates of obesity on the incidence and costs of type 2 diabetes, cardiovascular disease and stroke, arthritis, and several types of cancer in the USA and UK. If US trends based on historical data for 1988–2008 continue, the prevalence of obesity in US adults will increase from its present level of about 32% to about 50% by 2030, with increased costs of up to US$66 billion per year for treatment of obesity-associated diseases. If the UK trends for 1993–2008 continue, the prevalence of obesity will rise from 26% to 35–48% by 2030, depending on the sex considered, and the costs will increase by £2 billion per year. In both countries, the rate of increase in the prevalence of obesity has slowed in the past decade. Nonetheless, even when the more recent trends are taken into account, annual US and UK costs are still projected to increase by $48 billion and £1·9 billion, respectively, by 2030. As the authors show, even a modest 1% reduction in body-mass index (BMI) would substantially reduce the number of obesity-related diseases and their costs. |
The crab hole mosquito blues
Johnson KM , Antczak DF , Dietz WH , Martin DH , Walton TE . Emerg Infect Dis 2011 17 (5) 923-7 Venezuelan equine encephalomyelitis (VEE) epizoodemics were reported at 6-10-year intervals in northern South America beginning in the 1920s. In 1937, epizootic VEE virus was isolated from infected horse brain and shown as distinct from the North American equine encephalomyelitis viruses. Subsequently, epizootic and sylvatic strains were isolated in distinct ecosystems; isolates were characterized serologically as epizootic subtype I, variants A/B and C; or sylvatic (enzootic) subtype I, variants D, E, and F, and subtypes II, III, and IV. In 1969, variant I-A/B virus was transported from a major outbreak in northern South America to the borders of El Salvador, Guatemala, and Honduras. This musical poem describes the history and ecology of VEE viruses and the epidemiology of an unprecedented 1969 movement of VEE viruses from South America to equids and humans in Central America from Costa Rica to Guatemala and Belize and in Mexico and the United States that continued until 1972. |
The Feeding Infants and Toddlers Study 2008: opportunities to assess parental, cultural, and environmental influences on dietary behaviors and obesity prevention among young children
May AL , Dietz WH . J Am Diet Assoc 2010 110 S11-5 In 2007-2008, the prevalence of obesity was 10% among 2- to 5-year-old US children (1). Even in early childhood, significant racial/ethnic differences were apparent. Approximately 9% of non-Hispanic white, 11% non-Hispanic black, and 14% of Hispanic 2- to 5-year-old children were obese. Sex differences within racial/ethnic groups were also present. Obesity was least prevalent among non-Hispanic white (7%) and most prevalent among 2- to 5-year-old Hispanic boys (18%), whereas only modest differences were observed among non-Hispanic white, non-Hispanic black, and Hispanic 2- to 5-year-old girls (1). An elevated body mass index early in life is positively associated with adult adiposity (2). Although the causes of obesity are complex and multifaceted, at the most basic level, obesity is the result of an imbalance in energy intake and energy expenditure. Energy intake, specifically food consumption, is perhaps the most widely studied contributor to obesity. | This supplement to the Journal of the American Dietetic Association contains two articles (3, 4) that use data from the Feeding Infants and Toddlers Study (FITS) 2008 to describe food consumption of infants and toddlers and provide insights into the potential foods that may contribute to excess energy intake. FITS 2008 is a cross-sectional, national follow-up survey to FITS 2002. The survey methodology is described in this issue (5), but in short was composed of recruitment interviews and a 24-hour telephone dietary recall completed by parents or primary caregivers of infants and toddlers aged 0 to 48 months. Respondents completed questionnaires regarding family demographic characteristics, child development, and knowledge and attitudes about infant feeding. A random subsample of respondents provided an additional 24-hour dietary recall to estimate usual food intake. The FITS data presented in this issue of the Journal include the dietary intake data of 3,273 children: 382 infants aged 0 to 5.9 months, 505 infants aged 6 to 11.9 months, 925 toddlers aged 12 to 23.9 months, and 1,461 children aged 2 to 3 years (3, 4). This commentary highlights those studies and demonstrates their importance within the broader context of obesity prevention among young children. Children's eating patterns and food preferences are well established early in life (6). Therefore, the dietary behaviors that young children adopt during these critical periods of development may affect growth and health outcomes throughout the lifespan. Until recently, the frequency of food consumption among an adequate sample size of young children, especially those younger than age 2 years, was not well established. FITS was developed to address this gap by describing infant and toddler food consumption patterns (7). |
The identification of children with adverse risk factor levels by body mass index cutoffs from 2 classification systems: the Bogalusa Heart Study
Freedman DS , Fulton JE , Dietz WH , Pan L , Nihiser AJ , Srinivasan SR , Berenson GS . Am J Clin Nutr 2010 92 (6) 1298-305 BACKGROUND: The cutoffs from the Centers for Disease Control and Prevention (CDC) growth charts and from the Cooper Institute (FitnessGram) are widely used to identify children who have a high body mass index (BMI). OBJECTIVE: We compared the abilities of these 2 systems to identify children who have adverse lipid concentrations and blood pressure measurements and the reliability (consistency) of each classification system over time (mean follow-up: 7 y). DESIGN: A cross-sectional analysis based on data from 22,896 examinations of 5- to 17-y-olds was conducted. Principal components analyses were used to summarize levels of the 5 risk factors, and likelihood ratios and the kappa statistic were used to compare the screening abilities of the 2 systems. Of these children, 3972 were included in longitudinal analyses. RESULTS: There were marked differences in the prevalence of a high FitnessGram BMI by age, with the prevalence among boys increasing from 2.5% to 21% between the ages of 5 and 11 y. The identification of adverse risk factors by the 2 systems was only fair (kappa = 0.25), but there was little difference in the abilities of the CDC and FitnessGram cutoffs to identify high-risk children. Longitudinal analyses, however, indicated that the agreement between initial and follow-up FitnessGram classifications was substantially lower than that based on CDC cutoffs (kappa = 0.28 compared with 0.49). CONCLUSIONS: The FitnessGram and CDC cutoffs have similar abilities to identify high-risk children. However, a high FitnessGram BMI is difficult to interpret because the reliability over time is low, and the prevalence increases markedly with age. |
Changes and variability in high levels of low-density lipoprotein cholesterol among children
Freedman DS , Wang YC , Dietz WH , Xu JH , Srinivasan SR , Berenson GS . Pediatrics 2010 126 (2) 266-73 OBJECTIVE: A 2008 report from the American Academy of Pediatrics recommended both population and individual approaches (including pharmacologic interventions) for adolescents who had low-density lipoprotein (LDL) cholesterol levels above various cutoff points (130, 160, and 190 mg/dL). However, the tracking and variability of these very high levels have not been investigated. METHODS: A total of 6827 subjects underwent multiple LDL cholesterol determinations in childhood and adulthood in the Bogalusa Heart Study. The total number of determinations was 26748, and the median interval between examinations was 3 years. RESULTS: Correlations between initial and subsequent LDL cholesterol levels ranged from r approximately 0.8 for measurements made within the same year to r approximately 0.5 for periods of ≥20 years. Most children who had very high LDL cholesterol levels, however, had substantially lower levels at the next examination. LDL cholesterol levels between 160 and 189 mg/dL (n = 201) decreased, on average, by 21 mg/dL at the next examination, whereas levels of ≥190 mg/dL (n = 44) decreased by 34 mg/dL. In contrast, the mean increase for LDL cholesterol levels of <70 mg/dL was 13 mg/dL. These changes were equal to those expected on the basis of regression to the mean. CONCLUSIONS: There can be large changes in extreme levels of LDL cholesterol because of regression to the mean, and practitioners should be aware that very high levels may decrease substantially in the absence of any intervention. |
The relation of BMI and skinfold thicknesses to risk factors among young and middle-aged adults: the Bogalusa Heart Study
Freedman DS , Katzmarzyk PT , Dietz WH , Srinivasan SR , Berenson GS . Ann Hum Biol 2010 37 (6) 726-37 OBJECTIVE: Although adverse levels of cardiovascular disease risk factors are related to skinfold thicknesses and BMI among adults, the relative strengths of these associations are unknown. We examine whether the triceps and subscapular skinfold thicknesses are more strongly related to adult levels of lipids, fasting insulin and blood pressure than BMI. DESIGN AND SUBJECTS: Cross-sectional (n = 3318) and longitudinal (n = 1593) analyses of 18- to 44-year-olds examined in the Bogalusa Heart Study from 1983 to 2002. Principal components analysis was used to derive a summary index of the six examined risk factors (triglycerides, low- and high-density lipoprotein cholesterol, insulin, and systolic and diastolic blood pressures). RESULTS: The magnitudes of the differences were generally small, but all comparisons indicated that BMI was at least as strongly related to adverse risk factor levels as was the sum of subscapular and triceps skinfold thicknesses (SF sum). For example, adjusted cross-sectional associations with the risk factor summary were r = 0.55 (BMI) and r = 0.49 (SF sum), p < 0.001 for difference between correlations. Similar differences were seen in longitudinal analyses, with changes in the risk factor summary being more strongly associated with changes in BMI (r = 0.50) than with changes in the SF sum (r = 0.38). CONCLUSION: BMI appears to be at least as accurate as skinfold thicknesses in identifying metabolic risk among adults. The advantages of BMI should be considered in the design and interpretation of clinical and epidemiologic studies. |
Putting physical activity into public health: a historical perspective from the CDC
Pratt M , Epping JN , Dietz WH . Prev Med 2009 49 (4) 301-2 This commentary reviews the role that the U.S. Centers for Disease Control and Prevention (CDC) has played since 1964 in moving science, policy, and practice from exercise and fitness to physical activity and health. |
Obesity in neurology practice: a call to action
Trevathan E , Dietz WH . Neurology 2009 73 (9) 654-5 Childhood obesity, defined as a body mass index (BMI; weight [kg]/height [m2]) ≥95th percentile for children or adolescents of the same age and sex, now affects 16% of 2- to 19-year-olds in the United States. An additional 15% are overweight, defined as a BMI between the 85th and 95th percentiles.1 Recent estimates suggest that 70% of obese children have at least one additional cardiovascular disease risk factor, like elevated blood pressure, hyperlipidemia, or hyperinsulinemia, and almost 40% have 2 or more.2 The obesity epidemic among children is now a national crisis to which we must all respond. | In this issue of Neurology®, researchers from Cincinnati Children’s Hospital raise the possibility that obesity is associated with new onset childhood epilepsy.3 In the selection of their control populations, the authors have tried to demonstrate that the increased prevalence of obesity among children with new onset seizures is unique to these patients and not a consequence of a sampling bias. Their observation that African Americans and Hispanics, among whom the prevalence of obesity is increased, were underrepresented in the new onset seizure group compared to a local control helps allay this concern about sampling. |
Obesity prevention and control: from clinical tools to public health strategies
Belay B , Dietz WH . Acad Pediatr 2009 9 (5) 291-2 Four papers in this issue of Academic Pediatrics address several key aspects of the clinical and community approach to the obesity epidemic. Despite the centrality of body mass index to the assessment of obesity, the study by Oettinger and colleagues1 demonstrates that few parents in that sample had a clear understanding of the meaning of the measure. Nonetheless, the color-coding intervention of the growth charts to demonstrate healthy weight, overweight, and obesity increased parental understanding of risk. The high prevalence of severe obesity reported by Skelton and colleagues2 emphasizes again the importance of the need for tertiary centers to care for this high-risk population. | However, successful control of the obesity epidemic will require not only changes in how we deliver medical care for this widespread disease but also complementary changes in the environment. The contribution of the environment to childhood and adolescent obesity is emphasized by Galvez and colleagues3 and Oreskovic and colleagues,4 who demonstrate that access to convenience stores and fast-food restaurants is associated with an increased prevalence of obesity. It also appears that the opposite is true—that increased access to supermarkets has been inversely related to adolescent body mass index.5 Access affects both sides of the energy balance equation. On the energy expenditure side, community infrastructure such as sidewalks and recreational facilities fosters physical activity and may also play a role in the prevention and control of obesity.6 |
Introduction to issues and implications of screening, surveillance, and reporting of children's BMI
Dietz WH , Story MT , Leviton LC . Pediatrics 2009 124 S1-2 On January 16 and 17, 2008, the Robert Wood Johnson Foundation convened a forum of researchers and practitioners working on the issue of childhood obesity to discuss the issues related to surveillance, screening, and reporting of children's BMI. Because obesity has become a major concern of the foundation, it seemed essential to understand the use and limitations of the BMI measurement on which the diagnosis of obesity depended. The goals of the meeting were to gather and review experience in the collection of BMI data and to understand how to communicate BMI results to parents. In addition, the group explored cultural differences in how the BMI was interpreted, and considered the legal and confidentiality implications of collecting and reporting BMI data. | Because of the ease and reliability of measures of height and weight that are used to calculate BMI, BMI is the recommended measure for the identification of overweight and obesity. Obesity in children and adolescents, defined as a BMI at ≥95th percentile for age and gender, provides a useful measure of risk of metabolic complications and persistence. Furthermore, weight increases above the 95th percentile almost always reflect increases in body fatness. Overweight, defined as a BMI between the 85th and 95th percentiles for age and gender, is associated with a lower risk of metabolic complications or persistence. |
Issues and implications of screening, surveillance, and reporting of children's BMI
Dietz WH , Story MT , Leviton LC . Pediatrics 2009 124 S98-101 A robust discussion followed the presentation of each paper at the forum. In the sections below we have tried to capture the most salient points raised during the discussion. As a result, many of these points were not considered in the articles that comprise this supplement but are highly relevant to the screening, surveillance, and reporting of BMI. |
Classification of body fatness by body mass index-for-age categories among children
Freedman DS , Wang J , Thornton JC , Mei Z , Sopher AB , Pierson RN Jr , Dietz WH , Horlick M . Arch Pediatr Adolesc Med 2009 163 (9) 805-11 OBJECTIVE: To examine the ability of various body mass index (BMI)-for-age categories, including the Centers for Disease Control and Prevention's 85th to 94th percentiles, to correctly classify the body fatness of children and adolescents. DESIGN: Cross-sectional. SETTING: The New York Obesity Research Center at St Luke's-Roosevelt Hospital from 1995 to 2000. PARTICIPANTS: Healthy 5- to 18-year-old children and adolescents (N = 1196) were recruited in the New York City area through newspaper notices, announcements at schools and activity centers, and word of mouth. MAIN OUTCOME MEASURES: Percent body fat as determined by dual-energy x-ray absorptiometry. Body fatness cutoffs were chosen so that the number of children in each category (normal, moderate, and elevated fatness) would equal the number of children in the corresponding BMI-for-age category (<85th percentile, 85th-94th percentile, and > or =95th percentile, respectively). RESULTS: About 77% of the children who had a BMI for age at or above the 95th percentile had an elevated body fatness, but levels of body fatness among children who had a BMI for age between the 85th and 94th percentiles (n = 200) were more variable; about one-half of these children had a moderate level of body fatness, but 30% had a normal body fatness and 20% had an elevated body fatness. The prevalence of normal levels of body fatness among these 200 children was highest among black children (50%) and among those within the 85th to 89th percentiles of BMI for age (40%). CONCLUSION: Body mass index is an appropriate screening test to identify children who should have further evaluation and follow-up, but it is not diagnostic of level of adiposity. |
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